Healthcare Provider Details

I. General information

NPI: 1255740726
Provider Name (Legal Business Name): AMANDA SCHLOSSBERG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CHARLES ST SUITE 200
BALTIMORE MD
21201-4102
US

IV. Provider business mailing address

201 N. CHARLES STREET SUITE 200
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-576-9191
  • Fax: 410-576-9257
Mailing address:
  • Phone: 410-576-9191
  • Fax: 410-576-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC6683
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: